Section B: Employee Information: Fill out & sign online

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Click ‘Get Form’ to open the Employee Enrollment Application in the editor.
Begin with the Social Security Number field. Enter your SSN clearly, as this is crucial for identification.
Fill in your Last Name and First Name. Ensure that these match your official documents for accuracy.
Provide your Street Address, including Apt. # if applicable, followed by City, County, State, and Zip Code.
Enter your Phone number for contact purposes. This should be a number where you can be easily reached.
If applicable, include your Physician's Name and ID number if you are enrolling in an HMO plan.
Select your Sex and Marital Status from the provided options. This information is essential for demographic purposes.
Indicate whether you are an Existing Patient and select your Language of Preference if desired.
Lastly, check any applicable Ethnicity options to complete this section accurately.

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Versions	Form popularity	Fillable & printable
2019	4.5 Satisfied (76 Votes)
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What is list A or list B and C?

the documents are either one unexpired document from List A (documents showing both identity and work authorization), or one unexpired document from List B (documents showing identity) and one unexpired document from List C (documents showing work authorization);

What goes in list B on I-9?

List B Documents School ID card with a photograph. Example image not available. Voters registration card. U.S. Coast Guard Merchant Mariner Card. Native American tribal document. Drivers license issued by a Canadian government authority. For persons under age 18 who are unable to present a document listed above:

What should be on an employee information form?

Background Checks. California employers have the right to perform a lawful background check, which can provide them with highly sensitive and personal information. They can access your criminal record, credit report, driving record, and immigration record.

What is list B on i9?

This includes the individuals full name, contact information, date of birth, Social Security or Tax Identification number, emergency contacts, employment details such as position and date of hire, compensation, tax information, and potentially relevant medical information.

Does E-Verify require a list b document?

One document from List B (document that establishes identity) AND one document from List C (document that establishes employment authorization). *If you are an E-Verify employer, you may only accept List B documents that contain a photograph. Employees of E-Verify employers must provide their Social Security Number.